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Dental Coverage – Is it worth having?

Whether dental coverage is worth having is a question we are frequently asked. Our answer: It depends. When dental coverage is offered to you through an employer, it is, like most benefits, heavily subsidized and it rarely makes sense NOT to enroll in dental.

However, if you are self-employed, have individual coverage, or are on original Medicare, situations where you don’t, as an adult, have access to subsidized dental, that is a different matter. (Individual coverage includes some pediatric dental coverage for those under 19 years of age).

First, let’s remind everyone that annual dental benefits tend to be far more limited than people realize. $1,000 and $1,500 maximum payouts per person per year are common. Yes, we see plans that have a maximum payout of $2,000 or $2,500 or even $3,000 per person but those are not as common. In sum, we don’t believe dental coverage should even be referred to as dental insurance because the benefit is fairly limited. It would be clearer if the term “insurance” were reserved for coverage applicable to truly devastating events where you want a group of people paying into a fund to avoid such a ruinous event.

Anyway, when you are paying for dental coverage yourself and you and/or family members only have regular cleanings, you are likely to have overpaid for the coverage compared to paying out-of-pocket. Conversely, in the years you require services, you may be frustrated by how the dental benefit is structured because the structure can make it difficult for one to approach the maximum payout. Basic restorative work such as fillings and root canals, are often covered at 80% although sometimes as little as 50% and major restorative work such as crowns and bridges is typically covered at 50%. Also, many individual plans have waiting periods for all but cleanings so that can also frustrate.

Dental networks have become much more common too so if you end up using a dentist who is out-of-network with your dental coverage, you are likely to feel that very little is being covered. And, also, with out-of-network dentists you are likely to have to submit claims which means keeping track of claims. There are also dental HMOs with no out-of-network benefit so factor network status into your shopping. And, of course, there are some very limited plans available so you must read the fine print.

The fact is that when a dental benefit is subsidized, some entity is helping you afford it. When a dental benefit is not subsidized, it is being offered by an insurer who is in the business to make a profit.

Medicare does not cover routine dental so that is often a great disappointment to people going onto Medicare who have had group coverage. Many, however, are not even aware of how little value their dental coverage provided. The fact is, dental care is extremely important to your health so you need to identify a way to plan to pay for it when you are older. If you have the opportunity to have a high-deductible plan with a health savings account, building up a nest egg in the health savings account is one way to do that. But most people without subsidized dental coverage simply pay for dental expenses on their own.

Some still find having individual dental coverage desirable. If you are in that group, check with your dentist’s office to obtain their opinion on what coverage an individual can buy that seems to be working for other patients. After all, life is full of choices. But remember, when you are paying for dental coverage yourself, it is often not a good financial arrangement.

Let us know your comments and thoughts and please watch the video!